Provider Demographics
NPI:1194108407
Name:MARTINO, NICOLE (MS, DMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:MARTINO
Suffix:
Gender:F
Credentials:MS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7603 SEMINOLE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4888
Mailing Address - Country:US
Mailing Address - Phone:727-391-0269
Mailing Address - Fax:727-398-4992
Practice Address - Street 1:7603 SEMINOLE BLVD STE B
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4888
Practice Address - Country:US
Practice Address - Phone:727-391-0269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist